Bottom Line:
Compared with 10 patients with similar characteristics who did not receive ASCT, event free survival at 5-year was significantly superior in ASCT group.Toxicity of ASCT was acceptable and therapy-related death was not observed.We therefore propose that upfront ASCT for higher risk DLBCL in CR1 might provide survival benefit, probably because the high-dose therapy removes minimally resided tumor.

ABSTRACTHigh-dose chemotherapy followed by autologous stem cell transplantation (ASCT) has been applied to patients with diffuse large Bcell lymphoma (DLBCL); it is well established that ASCT shows significant survival benefits for chemosensitive relapse. However, half of relapsed patients are resistant to salvage chemotherapy, indicating that they are not suitable for ASCT. We retrospectively analyzed the clinical records of 47 patients with DLBCL classified as high or high-intermediate (higher) risk, according to the International Prognostic Index, who underwent upfront ASCT in first complete remission (CR1). Compared with 10 patients with similar characteristics who did not receive ASCT, event free survival at 5-year was significantly superior in ASCT group. Toxicity of ASCT was acceptable and therapy-related death was not observed. We therefore propose that upfront ASCT for higher risk DLBCL in CR1 might provide survival benefit, probably because the high-dose therapy removes minimally resided tumor.

Mentions:
Ten patients in CR1, who did not undergo ASCT, were also analyzed as control group (Table 1). Their survival time was calculated starting from the completion of the 8 cycles of (R-)CHOP instead of ASCT. When we compared both groups (with and without ASCT) using U-test for distribution of age, serum LDH, interleukin-2 receptor (IL-2R) at presentation and chi-square test for proportion of the presence of B-symptom, extranodal lesion, risk classification by IPI, and administration of R, no difference was showed. However, a significantly larger proportion of patients with stage IV was revealed in ASCT group compared with non-ASCT group (P<0.05 by chi-square test). Therefore, we considered that inadequate bias between the 2 groups was minimized. With a median observation period of 61 months (ranging from 11 to 264), 14 patients of ASCT group relapsed. Their relapse sites was brain in 3 patients, bone marrow in 2, testis and liver in 1, respectively. Nodal relapse was seen in the remaining 7. Event-free survival (EFS) of patients who underwent ASCT was 75.8% after 5 years. This was significantly superior to that of those who did not (45%, P=0.03) (Figure 1). Although overall survival (OS) at 5 years tended to be better in ASCT group (79% vs 52.5%), no statistical significance was seen (P=0.18). Among ASCT group, age difference, normal or elevated LDH value, localized or advanced stage, presence or absence of extranodal lesion, high or high-intermediate risk by IPI, or normal or elevated serum IL-2R did not affect EFS (Table 3). Unexpectedly, use of R was associated with a tendency of shorter survival (5-year OS 80.5% vs 67.6%; P=0.25, EFS 80.5% vs 58.4%, P=0.08).

Mentions:
Ten patients in CR1, who did not undergo ASCT, were also analyzed as control group (Table 1). Their survival time was calculated starting from the completion of the 8 cycles of (R-)CHOP instead of ASCT. When we compared both groups (with and without ASCT) using U-test for distribution of age, serum LDH, interleukin-2 receptor (IL-2R) at presentation and chi-square test for proportion of the presence of B-symptom, extranodal lesion, risk classification by IPI, and administration of R, no difference was showed. However, a significantly larger proportion of patients with stage IV was revealed in ASCT group compared with non-ASCT group (P<0.05 by chi-square test). Therefore, we considered that inadequate bias between the 2 groups was minimized. With a median observation period of 61 months (ranging from 11 to 264), 14 patients of ASCT group relapsed. Their relapse sites was brain in 3 patients, bone marrow in 2, testis and liver in 1, respectively. Nodal relapse was seen in the remaining 7. Event-free survival (EFS) of patients who underwent ASCT was 75.8% after 5 years. This was significantly superior to that of those who did not (45%, P=0.03) (Figure 1). Although overall survival (OS) at 5 years tended to be better in ASCT group (79% vs 52.5%), no statistical significance was seen (P=0.18). Among ASCT group, age difference, normal or elevated LDH value, localized or advanced stage, presence or absence of extranodal lesion, high or high-intermediate risk by IPI, or normal or elevated serum IL-2R did not affect EFS (Table 3). Unexpectedly, use of R was associated with a tendency of shorter survival (5-year OS 80.5% vs 67.6%; P=0.25, EFS 80.5% vs 58.4%, P=0.08).

Bottom Line:
Compared with 10 patients with similar characteristics who did not receive ASCT, event free survival at 5-year was significantly superior in ASCT group.Toxicity of ASCT was acceptable and therapy-related death was not observed.We therefore propose that upfront ASCT for higher risk DLBCL in CR1 might provide survival benefit, probably because the high-dose therapy removes minimally resided tumor.

ABSTRACTHigh-dose chemotherapy followed by autologous stem cell transplantation (ASCT) has been applied to patients with diffuse large Bcell lymphoma (DLBCL); it is well established that ASCT shows significant survival benefits for chemosensitive relapse. However, half of relapsed patients are resistant to salvage chemotherapy, indicating that they are not suitable for ASCT. We retrospectively analyzed the clinical records of 47 patients with DLBCL classified as high or high-intermediate (higher) risk, according to the International Prognostic Index, who underwent upfront ASCT in first complete remission (CR1). Compared with 10 patients with similar characteristics who did not receive ASCT, event free survival at 5-year was significantly superior in ASCT group. Toxicity of ASCT was acceptable and therapy-related death was not observed. We therefore propose that upfront ASCT for higher risk DLBCL in CR1 might provide survival benefit, probably because the high-dose therapy removes minimally resided tumor.